Even in the absence of definitive science on the potential hazards surrounding the use of electronic cigarettes, regulations are needed now to head off health concerns. One such restriction should be a ban on indoor use of the devices. That’s according to the World Health Organization in a new report the international body published on August 26. Electronic cigarettes, the organization states, “represent an evolving frontier, filled with promise and threat for tobacco control.” The popular devices deliver an aerosolized solution to users by a heating a nicotine solution that users inhale.

In the past nine years the e-cigarette industry has exploded to include more than 400 brands in a roughly $3-billion industry. Yet flavorings that attract children, poor quality control between brands and apparent rapid experimentation among adolescent users (with e-cig use doubling in that group from 2008 to 2012) has triggered growing fears that e-cigs are the new gateway drug. Just in the U.S. the Centers for Disease Control and Prevention reported earlier this week that more than a quarter million youth who had never smoked traditional tobacco cigarettes used e-cigs last year—representing a roughly three-fold increase from 2011 to 2013.

The WHO report details potential regulatory options countries could consider, including blocking e-cig manufacturers from making health claims about the devices that suggest they are effective smoking cessation aids (unless and until they are scientifically proved as such), banning e-cig use in public places and restricting advertising for the products. Other recommendations from the roughly 100 scientists and regulators that contributed to the report include subjecting the devices to the same surveillance and monitoring typical for tobacco products, restricting sales to minors and possibly requiring health warnings on the packaging.

E-cig aerosol “is not merely water vapor as is often claimed in the marketing for these products,” WHO wrote. Most of these gadgets “have not been tested by independent scientists, but the limited testing has revealed wide variations in the nature of the toxicity of contents and emissions.” Factors including how long and deep users puff on e-cigarettes, the lack of uniformity in the e-cig flavoring solutions and the possibility that users could potentially overdose on the nicotine found in the liquid—or that the drug may contribute to other health risks—must all be considered, the agency says.

The international health organization recommends that smokers attempting to quit should first turn to tried-and-true methods such as the patch and nicotine gum before turning to e-cigarettes. The 13-page report was published in six languages.

The organization’s dispatch, commissioned by the governing body of the WHO Framework Convention on Tobacco Control, was published even as the U.S. government continues to grapple with deciding how it will approach the devices. The U.S. Food and Drug Administration in April proposed regulations for e-cigarettes that have not yet been finalized. Those regulations, if enacted, would block youths from buying e-cigarettes and require health warnings on the products. They would not, however, ban advertising nor online sales, which critics contend allow minors easy access to the devices.

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